A REPORTER'S TOOLKIT: CHILD HEALTH COVERAGE

An Alliance for Health Reform Toolkit -
Produced with support from the Robert Wood Johnson Foundation

This toolkit offers links to resources that will help you understand how children in the U.S. get health coverage, and the importance of employer-sponsored coverage and public programs to children. We offer an overview of the State Children's Health Insurance Program (SCHIP), with an update on congressional reauthorization of the program. This resource also offers key facts, story ideas for reporters, selected experts with contact information, selected websites, and a glossary.

Table of Contents

This toolkit was compiled and written by Sam Takvorian.

 

Key Facts

  • Uninsured children are much more likely than insured children to have unmet medical needs. 1
  • Nearly 8.7 million children in the U.S. lacked health insurance for all of 2006, up from 8 million in 2005, according to the latest Census Bureau data. 2
  • Uninsured rates for children vary dramatically by state, from a 2005-2006 low of 5 percent in Michigan to a high of 21 percent in Texas. 3
  • Largely due to public coverage, the uninsured rate is significantly lower among children than adults. In 2006, 11.7 percent of children were uninsured, compared to 17.2 percent of all adults (20.2 percent of non-elderly adults). 4
  • About 28 million children were covered through Medicaid for at least part of 2006. 5 Most children on Medicaid qualify based on family income, but children may also qualify for Medicaid through other, largely disability-based, eligibility categories.
  • Approximately 6.6 million children were enrolled at some time during 2006 in the State Children's Health Insurance Program (SCHIP), which helps cover children who lack health insurance but do not qualify for Medicaid.6
  • Legislation reauthorizing and expanding SCHIP passed in the U.S. House and Senate in September 2007. President Bush vetoed the legislation. At press time, neither chamber of Congress had overridden the veto.

Selected Resources

Please email info@allhealth.org if you find that any of the links mentioned in this toolkit no longer work.

Child Health Coverage Statistics

Children and Private Coverage

The State Children's Health Insurance Program (SCHIP): An Overview

Enrollment in SCHIP and Medicaid

SCHIP & Crowd-Out

SCHIP Reauthorization: Issues in the Current Debate
(For the latest developments on SCHIP reauthorization, see the four links at the bottom of this section.)

For Updates on SCHIP Reauthorization:

Story Ideas

  • Some 14 states were facing SCHIP funding shortfalls on October 1, 2007. 26 These states were Alaska, Georgia, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, Rhode Island and Wisconsin. What's the latest with SCHIP funding in your state?
  • Coming out of tight fiscal times, some states are again looking to expand and improve children's coverage. If your state is expanding coverage, are policymakers and the public pleased with the results?
  • The Deficit Reduction Act allows states, for the first time, to charge children in Medicaid co-payments and in some cases premiums. Is your state imposing new copayments? Is there a discernible impact on children's enrollment and access to care? If there are copays that families cannot pay, are they being turned away by providers?
  • The DRA requires states to collect documents from families to prove citizenship before their children can be enrolled in Medicaid (this new requirement applies just to citizen children; immigrant children are already subject to verification requirements). How is this new rule working, or has your state decided to delay this requirement? What is the impact on enrollment numbers?
  • "Waivers" allow states to operate their Medicaid programs in ways that do not conform to regular federal rules. Does your state have a waiver in progress or in the planning stage for children's coverage under SCHIP or Medicaid? If so, are the benefits offered under the waiver richer or leaner? Is income eligibility easier? What is the impact on costs for families and the state?
  • Do uninsured children in your area have any access to health care services outside of the emergency room? How reliable are such services, what is the quality, and what do they cost?
  • How are the current SCHIP guidelines impacting your state? Will some children lose coverage as a consequence? How is your state responding to this?

Selected Experts

Drawn from the Alliance for Health Reform's Find-an-Expert Service for reporters. Descriptions in quotes are written by the experts themselves. Credentialed reporters can see full profiles for these and other experts, including after-hours contact numbers, by going to www.allhealth.org/reporter_enroll.asp

  • JOAN ALKER
    Senior Researcher, Center for Children and Families, Georgetown University
    Washington DC 20057-1485
    202-784-4075
    jca25@georgetown.edu
  • CHRISTINA BETHELL
    Associate Professor/Director, Oregon Health & Science Univ. School of Medicine, Dept. of Pediatrics, The Child and Adolescent Health Measurement Initiative
    Portland OR 97239
    503-494-1892
    bethellc@ohsu.edu
  • M. GREGG BLOCHE
    Nonresident Senior Fellow, Economic Studies, The Brookings Institution
    1775 Massachusetts Ave., NW, Washington, DC 20036
    202-797-6274
    bloche@law.georgetown.edu
  • RICHARD BUCCIARELLI
    Vice President for Government Relations, University of Florida
    Gainesville FL 32611-3157
    352-392-4574
    buccirl@ufl.edu
  • STUART M. BUTLER
    Vice President, Domestic and Economic Policy Studies, Heritage Foundation
    214 Massachusetts Ave, NE, Washington, DC 20002
    202-75-1761
    butlers@heritage.org
  • MICHAEL F. CANNON
    Director of Health Policy Studies, Cato Institute
    1000 Massachusetts Avenue, NW Washington, DC 20001
    202-789-5200
    mcannon@cato.org
  • OLIVIA CARTER-POKRAS
    Associate Professor, University of Maryland School of Medicine, Department of Epidemiology and Preventive Medicine
    Baltimore MD 21201-1596
    410-706-0463
    opokras@epi.umaryland.edu
  • NANCY CHOCKLEY
    President and CEO, NIHCM Foundation
    Washington, D.C. DC 20016
    202-296-5052
    NChockley@NIHCM.org
  • GARY CLAXTON
    Vice President, Director, Health Care Marketplace Project, Henry J. Kaiser Family Foundation
    Washington DC 20005
    202-347-5270
    gclaxton@kff.org
  • KAREN DAVENPORT
    Director of Health Policy, Center for American Progress
    Washington DC 20005
    202-741-6368
    kdavenport@americanprogress.org
  • MICHAEL DAVERN
    Assistant Professor, Health Policy & Management School of Public Health
    University of Minnesota
    Mayo Mail Code 729
    420 Delaware Street S.E.
    Minneapolis, MN 55455-0392
    612-624-6151
    hpm@umn.edu
  • KAREN DAVIS
    President, The Commonwealth Fund
    New York NY 10021
    212-606-3825
    kd@cmwf.org
  • LISA DUBAY
    Associate Professor, Johns Hopkins Bloomberg School of Public Health
    Baltimore, MD 21205
    410-502-0985
    ldubay@jhsph.edu
  • PAUL FRONSTIN
    Director, Health Research Program, Employee Benefit Research Institute
    Washington DC 20037
    202-775-6352
    fronstin@ebri.org
  • ROBYN GABEL
    Executive Director, Illinois Maternal and Child Health Coalition
    Chicago IL 60622
    312-491-8161
    rgabel@ilmaternal.org
  • ANNE GAUTHIER
    Senior Policy Director, The Commonwealth Fund
    Washington DC 20006
    202-292-6700
    ag@cmwf.org
  • PAUL GINSBURG
    President, Center for Studying Health System Change
    Washington DC 20024
    Contact Alwyn Cassil: 202-264-3484
    acassil@hschange.org
  • EDMUND F. HAISLMAIER
    Senior Research Fellow in Health Policy Studies, Heritage Foundation
    214 Massachusetts Ave, NE, Washington, DC 20002
    202-675-1761
    ed.haislmaier@heritage.org
  • MICHAEL HASH
    Principal, Health Policy Alternatives, Inc.
    Washington DC 20001
    202-737-3390
    mh.hpa@sso.org
  • ROBERT B. HELMS
    Resident Scholar, American Enterprise Institute
    1150 Seventeenth Street, NW, Washington, DC 20036
    202-862-5877
    rhelms@aei.org
  • JOHN HOLAHAN
    Director, Health Policy Center, The Urban Institute
    Washington DC 20037
    202-261 5666
    jholahan@ui.urban.org
  • EDWARD F. HOWARD
    Exec V-P, Alliance for Health Reform
    Washington DC 20005
    202-789-2300
    edhoward@allhealth.org
  • ANDREW HYMAN
    Senior Program Officer, Health Care Group, Robert Wood Johnson Foundation
    Princeton, NJ 08543
    609-627-576
    ahyman@rwjf.org
  • CHRIS JENNINGS
    President, Jennings Policy Strategies, Inc.
    Washington DC 20001
    202-879-9344
    ccj@jenningsps.com
  • GENEVIEVE KENNEY
    Principal Research Associate, The Urban Institute
    Washington DC 20037
    202-261-5568
    jkenney@ui.urban.org
  • ANN CLEMENCY KOHLER
    Deputy Commissioner, New Jersey Department of Human Services
    Trenton, NJ 08618
    609-984-6608
    ann.c.kohler@dhs.state.nj.us
  • LEIGHTON KU
    Senior Fellow, Center on Budget and Policy Priorities
    Washington DC 20010
    202-408-1080
    KU@CBPP.ORG
  • WENDY LAZARUS
    Founder and Co-President, The Children's Partnership
    Santa Monica CA 90401
    310-260-1220
    wlazarus@childrenspartnership.org
  • JOHN LEWY
    Immediate Past Chairman, Committee on Federal Government Affairs, American Academy of Pediatrics
    Washington DC 20037
    202-253-7390
    jlewy@tulane.edu
  • TRUDI MATTHEWS
    Associate Director for Health Policy, The Council of State Governments
    Lexington KY 40578
    859-244-8157
    tmatthews@csg.org
  • LAWRENCE MCANDREWS
    President & CEO, National Association of Children's Hospitals
    Alexandria VA 22314
    703-684-1355
    lmcandrews@nachri.org
  • MARK MCCLELLAN
    Senior Fellow and Director, Engelberg Center for Health Care Reform, The Brookings Institution
    1775 Massachusetts Ave., NW, Washington, DC 20036
    202-741-6567
    mmcclellan@brookings.edu
  • BRENDAN MCTAGGART
    Communications Director, National Health Law Program
    Washington DC 20005
    202-289-7661
    brendan@healthlaw.org
  • ROBERT E. MOFFIT
    Director, Center for Health Policy Studies, Heritage Foundation
    214 Massachusetts Ave, NE, Washington, DC 20002
    202-546-4400
    Robert.Moffit@heritage.org
  • JUDITH MOORE
    Senior Fellow, National Health Policy Forum
    Washington DC 20037
    202-872-0292
    jdmoore@gwu.edu
  • ROSE NAFF
    Executive Director, Florida Healthy Kids Corporation
    Tallahassee FL 32302
    850-701-6101
    naffr@healthykids.org
  • LEN NICHOLS
    Director of Health Policy Program, New America Foundation
    Washington DC 20009
    301-801-3356
    lnichols@newamerica.net
  • NINA OWCHARENKO
    Senior Policy Analyst, Center for Health Policy Studies, Heritage Foundation
    214 Massachusetts Ave, NE, Washington, DC 20002
    202-675-1761
    nina.owcharenko@heritage.org
  • EDWIN PARK
    Senior Health Policy Analyst, Center on Budget & Policy Priorities
    Washington DC 20002
    510-524-8033
    park@cbpp.org
  • JAMES PERRIN
    Professor of Pediatrics, MGH Center for Child and Adolescent Health Policy
    Boston MA 02114
    617-726-8716
    jperrin@partners.org
  • RON POLLACK
    Executive Director, Families USA
    Washington, D.C. DC 20005
    202-628-3030
    rpollack@familiesusa.org
  • NICOLE RAVENELL
    President and CEO, Southern Institute on Children and Families
    Columbia, SC 29201
    803-779-2607
    NRavenell@thesoutherninstitute.org
  • MARTHA ROHERTY
    Director, National Association of State Medicaid Directors
    Washington DC 20002
    202-682-0100 ext. 299
    mroherty@aphsa.org
  • SARA ROSENBAUM
    Chair, Department of Health Policy, George Washington University
    Washington DC 20006
    202-530-2343
    sarar@gwu.edu
  • DIANE ROWLAND
    Executive Vice President, Kaiser Family Foundation
    Washington DC 20005
    202-347-5270
    drowland@kff.org
  • MATT SALO
    Director of Health Legislation, National Governors Association
    Washington DC 20001
    202-624-5336
    msalo@nga.org
  • JUDITH SOLOMON
    Senior Fellow, Center on Budget and Policy Priorities
    Washington DC 20002
    202-408-1080
    solomon@cbpp.org
  • JANET TRAUTWEIN
    Executive Vice President and CEO, National Association of Health Underwriters
    Arlington, VA 22201
    703-276-3806
    jtrautwein@nahu.org
  • REED TUCKSON
    Senior Vice President of Consumer Health and Medical Care Advancement, UnitedHealth Group
    Minnetonka MN 55343
    952-936-1256
    reed_v_tuckson@uhc.com
  • GRACE-MARIE TURNER
    President, Galen Institute
    Alexandria VA 22320
    202-299-8900
    gracemarie@galen.org
  • CORINNE WALENTIK
    Professor of Pediatrics-Division of Neonatology, SSS Cardinal Glennon Children's Hosp/Saint Louis University
    St. Louis MO 63104
    314-577-5642
    walentca@slu.edu
  • ELIE WARD
    Executive Director, Statewide Youth Advocacy
    Albany NY 12207
    518-436-8525
    esw@syanys.org
  • JUDY WAXMAN
    Vice President Health and Reproductive Rights, National Women's Law Center
    Washington DC 20009
    202-588 5180
    jwaxman@nwlc.org
  • ALAN WEIL
    Executive Director, Natl Academy for State Health Policy
    Washington DC 20036
    202-903-0101
    aweil@nashp.org
  • TIM WESTMORELAND
    Visiting Professor of Law, Research Professor of Public Policy, Georgetown University
    Washington DC 20007
    202-687-0880
    Westmort@law.georgetown.edu
  • PETERS WILLSON
    Vice President, Public Policy, National Association of Children's Hospitals
    Alexandria VA 22314
    703-797-6006
    pwillson@nachri.org
  • JUDITH WOOLDRIDGE
    Senior Vice President, Mathematica Policy Research
    Princeton NJ 08543-2393
    609-275 2370
    jwooldridge@mathematica-mpr.com

Selected Websites

Glossary on Children's Health Coverage

ADVANCEABLE TAX CREDIT - A subsidy to help pay for health insurance that is available when the insurance premium is due, without having to wait until a year-end tax return is filed. Also see "tax credit."

ACUTE CARE - Medical services provided to treat an illness or injury, usually for a short time. Contrast with "chronic care."

BLOCK GRANT - A lump sum of money given to a state or local government to be spent for certain purposes. Normally, it is based on a formula, the objectives are broadly defined and the grant's source places relatively few limits on the money's use.

CAPITATION - Method of payment for health services in which a health care provider is paid a fixed amount for each person on the provider's patient roster, regardless of the actual number or nature of services provided to each person.

CARVE-OUTS - A payer strategy in which an HMO or insurance company isolates ("carves out") a benefit and hires another organization to provide this service. Common carve-outs include behavioral health and prescription drugs. The technique is intended to allow the insurer to better control its costs.

CASE MANAGEMENT - A process where a health plan identifies covered persons with specific health care needs, then devises and carries out for them a plan to achieve the best patient outcome in the most cost-effective manner.

CATEGORICAL ELIGIBILITY - Medicaid's eligibility pathway for individuals who can be covered. The program's 25+ categories can be organized into five broad groups - children, pregnant women, adults in families with dependent children, individuals with disabilities and the elderly. Certain individuals, notably single adults without children, cannot qualify for Medicaid, even if their incomes are low enough to meet financial eligibility standards.

CHRONIC CARE - Medical services provided to those with chronic conditions. Contrast with "acute care."

CHURNING - The cycle involving a person's enrollment in a health insurance program (such as Medicaid or employer-sponsored coverage), then losing eligibility, the regaining it and re-enrolling.

COINSURANCE - A portion of the bill for a medical service, that is not covered by the patient's health insurance policy and therefore must be paid out of pocket by the patient. Coinsurance refers to a percentage, e.g., 10 percent of the total charge up to a specified maximum. Contrast with "copayment."

COMMUNITY HEALTH CENTER (CHC) - Organization providing comprehensive primary care to medically underserved populations, regardless of their ability to pay. These public and non-profit entities receive federal funding under Section 330 of the Public Health Service Act, as amended.

COPAYMENT - A flat dollar amount that a patient must pay out of pocket for a medical service, e.g. $5 per office visit.

COST SHIFTING - The practice by which a seller of a health service, such as a hospital, increases charges for some payers to offset losses due to uncompensated or indigent care or lower payments from other payers.

CROSS-SUBSIDY - The concept of certain purchasers paying more for medical services than they otherwise would so that others can pay less (or nothing at all), or another activity can be funded. In the U.S. health system, this mechanism has been used to pay for medical services for the poor and uninsured, medical education and research.

CROWD-OUT - A phenomenon whereby public programs or expansions of public programs designed to extend coverage to the uninsured encourage some employers to drop health coverage, urging their employees instead to take advantage of the expanded public subsidy.

DEDUCTIBLE - A fixed amount, usually expressed in dollars in the form of an annual fee, that the beneficiary of a health insurance plan must pay directly to the health care provider before a health insurance plan begins to pay for any costs associated with the insured medical service.

DEFICIT REDUCTION ACT OF 2005 (DRA) - The DRA made significant changes to the Medicaid program - for example, allowing states to increase premiums and cost-sharing for families and to base benefits on private plans. The law also tightened long-term care asset transfers and capped the amount of home equity that can be disregarded in measuring eligibility at $500,000. A DRA provision in effect since July 1, 2006 requires Medicaid beneficiaries to show proof of citizenship upon applying for or renewing their benefits. For more information, see www.kff.org/medicaid/7465.cfm.

DEFINED BENEFIT - A health insurance model used by an employer or government program where specified health services covered under the plan are standardized and guaranteed. The cost of providing the standard benefits may fluctuate. One example of a defined benefit plan is Medicare. Contrast with "defined contribution."

DEFINED CONTRIBUTION - A health benefit model used by employers or government programs where health services covered may fluctuate based on choice of plan, but the employer or government contributes a set amount (percentage or dollar amount) towards the purchase of the selected health plan. A defined contribution plan limits the financial liability of employers or the government, because the contribution is defined, or fixed. An example of a defined contribution plan is the State Children's Health Insurance Program. Contrast with "defined benefit."

DISPROPORTIONATE SHARE HOSPITAL (DSH) ADJUSTMENT - An increased payment under Medicare's prospective payment system or under Medicaid for hospitals that serve a relatively large number of low-income uninsured patients.

FEDERAL MEDICAL ASSISTANCE PERCENTAGE (FMAP) - Percentage used to determine the amount of federal matching funds for state Medicaid expenditures. By law, FMAP cannot be less than 50 percent or exceed 80 percent. Slightly higher Enhanced Federal Medical Assistance Percentages are used to determine matching payments for the State Children's Health Insurance Program (SCHIP). These payments cannot exceed 85 percent of the state's total SCHIP expenditures. For more information, see http://aspe.hhs.gov/health/fmap07.htm.

FEDERAL POVERTY GUIDELINES - Income amounts set each February by the U.S. Department of Health and Human Services used to determine an individual's or family's eligibility for various public programs, including Medicaid and the State Children's Health Insurance Program. Sometimes called Federal Poverty Level/Line (FPL). (The poverty guidelines are different from the U.S. Census Bureau's "poverty thresholds," which are used for Census statistical purposes.) For the 2007 poverty guidelines, see http://aspe.hhs.gov/poverty/07poverty.shtml,/A>

HEALTH INSURANCE FLEXIBILITY AND ACCOUNTABILITY (HIFA) DEMONSTRATION INITIATIVE - A Bush Administration initiative to encourage states to apply for certain Medicaid Section 1115 and SCHIP waivers. HIFA waivers make it possible for states to offer private health insurance coverage or employer-sponsored coverage, with subsidies, as an alternative to enrolling beneficiaries in traditional Medicaid or SCHIP.

HEALTH OPPORTUNITY ACCOUNT (HOA) - A type of health savings account for Medicaid beneficiaries created by the Deficit Reduction Act of 2005 . States may deposit annual sums of up to $2,500 per adult and $1,000 per child into the account, to be used to pay for medical expenses not covered by the high deductible health plan with which the account is coupled. Beginning January 1, 2007, as many as 10 states could initiate HOA demonstration projects. Compare to "Health Savings Account" and "Health Reimbursement Arrangement."

HOME AND COMMUNITY-BASED SERVICES (HCBS) - State-designed HCBS encompass case management, adult day care, home health aide assistance, personal care, assisted living services and respite care. Section 1915(c) of the Social Security Act permits the HHS Secretary to approve Medicaid waivers that allow for long-term care services to be delivered in community instead of institutional settings. The Deficit Reduction Act also created a new capped HCBS option that allows states to offer these services without having to obtain administrative waiver approval. See "Medicaid Section 1915 Waiver."

INTERGOVERNMENTAL TRANSFER (IGT) - Transfer of funds among or between different levels of government, including state-owned or operated facilities and local governments. The term is most often used in Medicaid, where transfers of non-federal public funds to the state Medicaid agency are used to draw down federal matching funds. States also use IGTs to draw down federal "disproportionate share hospital adjustment" and "upper payment limit" funds.

MANAGED CARE - Care provided by a health care organization, such as a health maintenance organization (HMO) or preferred provider organization (PPO), that contracts to provide medical services to a group of enrollees in exchange for capitated monthly premiums. Payments to physicians and other practitioners in HMOs are often lower than fee-for-service payments.

MEANS-TESTING - Determining eligibility for government benefits based on an individual's lack of means, as measured by income and/or assets. Under Medicaid, means-testing differs for different eligibility groups (see "categorical eligibility").

MEDICAID - Public health insurance program that provides coverage for an estimated 60 million low-income persons for acute and long-term care. It is financed jointly by state and federal funds (the federal government pays at least 50 percent of the total cost in each state), and is administered by states within broad federal guidelines. Contrast with "Medicare."

MEDICAID SECTION 1115 WAIVER - Under Section 1115(a) of the Social Security Act, the secretary of Health and Human Services may waive most provisions of Medicaid law for demonstrations "likely to assist in promoting the objectives" of the program. Under long-standing policy, these waivers must be cost-neutral. Demonstration waivers may be granted for research purposes, to test a program improvement, or investigate a new way of delivering services.

MEDICALLY NEEDY - A Medicaid category for income eligibility in which states can choose to cover individuals and families who quality for coverage because of high medical expenses, usually for hospital or nursing home care. To qualify, individuals must be categorically eligible and their monthly incomes minus accumulated medical bills must be below state income limits for the Medicaid program. This allows Medicaid coverage for people who have extensive health care needs but too much income to be eligible for Medicaid. Also see "spend-down."

MEDICARE - Federal health insurance program for virtually all persons age 65 and older, and permanently disabled persons under age 65, who qualify by receiving Social Security Disability Insurance. Contrast with "Medicaid."

PREMIUM ASSISTANCE - The use of federal funds available through public health coverage programs -- especially Medicaid and the State Children's Health Insurance Program -- to purchase or help purchase private insurance.

PRIMARY CARE CASE MANAGEMENT, INITIATIVE, OR CLINICIAN - (PCCM/PCI/PCC) - A Medicaid managed care program in which an eligible individual may use services only with authorization from his or her assigned primary care provider. That provider is responsible for locating, coordinating, and monitoring all primary and other medical services for enrollees. Those services are usually paid on a fee-for-service basis.

SAFETY NET PROVIDERS - Providers that have a primary focus of servicing low-income and uninsured people. They include community and migrant health centers and public hospitals.

SPEND-DOWN - Process by which individuals in many states can qualify for Medicaid because high medical expenses, usually hospital or nursing home care, reduce their monthly income to below state income limits for the Medicaid program. The amount that each individual must "spend down" is determined at the time eligibility is determined. Also see "medically needy."

STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP) - A program enacted by Congress in 1997 that provides federal matching funds for states to spend on health coverage for uninsured kids. The program is designed to reach uninsured children whose families earn too much money to qualify for Medicaid but not enough to afford private coverage.

SUPPLEMENTAL SECURITY INCOME (SSI) - A federal income support program for low-income disabled, aged and blind individuals. Eligibility for SSI monthly cash payments does not depend on previous employment or contributions to a trust fund. Eligibility for SSI usually confers eligibility for Medicaid.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) - The block grant program that, in 1996, replaced categorical welfare assistance such as Aid to Families with Dependent Children. Under TANF, time limits are set for cash benefits, and recipients are expected to accept work or be enrolled in training programs. TANF was reauthorized in 2005 as part of the Deficit Reduction Act with $16.4 billion in annual funding through FY 2010. For more information, see www.acf.hhs.gov/programs/ofa/.

TRANSITIONAL MEDICAL ASSISTANCE (TMA) - Medicaid coverage for up to one year for families leaving welfare to become self-supporting through work. During this transition period, states are required to continue Medicaid benefits even if earnings increase. For more information, see http://opencrs.cdt.org/document/RL31698/.

UPPER PAYMENT LIMIT (UPL) - Federal regulatory payment limit governing what states can pay eligible public facilities for Medicaid services. The UPL is usually the rate Medicare would pay for the same service. In some cases, states request federal matching funds in amounts that exceed the state's standard Medicaid reimbursement rate, and use the new revenues generated for other goods or services. Also see "Intergovernmental Transfer."

WAIVER (MEDICAID SECTION 1115 WAIVER) - Under Section 1115(a) of the Social Security Act, the secretary of Health and Human Services may waive most provisions of Medicaid law for demonstrations "likely to assist in promoting the objectives" of the program. Under long-standing policy, these waivers must be cost-neutral. Demonstration waivers may be granted for research purposes, to test a program improvement, or investigate a new way of delivering services.

Endnotes

1 Kaiser Commission on Medicaid and the Uninsured, "The Uninsured: A Primer," Figure 7, p.8, October 2007 (www.kff.org/uninsured/upload/7451-03.pdf) and "No Shelter From the Storm: America's Uninsured Children," Families USA, Campaign for Children's Health Care, September 2006, pp. 7-8 (www.childrenshealthcampaign.org/tools/reports/Uninsured-Kids-report.PDF)

2 U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. "Table 6. People with or without health insurance coverage by selected characteristics: 2005 and 2006." www.census.gov/hhes/www/hlthins/hlthin06/p60no233_table6.pdf Retrieved August 30, 2007.

3 Kaiser State Health Facts, "Health Insurance Coverage of Children 0-18, States (2005-6), U.S. (2006)" Available at: http://www.statehealthfacts.org/comparetable.jsp?ind=127&cat=3&yr=1&typ=2&sort=162&o=a Retrieved September 24, 2007.

4 Alliance for Health Reform analysis of U.S. Census Bureau Data: U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. "Table 6. People with or without health insurance coverage by selected characteristics: 2005 and 2006." Available at: http://www.census.gov/hhes/www/hlthins/hlthin06/p60no233_table6.pdf Retrieved August 30, 2007; U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. "Table HI05. Health Insurance Coverage Status and Type of Coverage by State and Age for All People: 2006." Available at: http://pubdb3.census.gov/macro/032007/health/h05_000.htm. Retrieved September 28, 2007.

5 Leighton Ku et al., "Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP," Center on Budget and Policy Priorities (January 2007), p. 2. www.cbpp.org/schip-chartbook.pdf

6 Congressional Budget Office, "State Children's Health Insurance Program," (May 2007), p vii. Available at: http://www.cbo.gov/ftpdocs/80xx/doc8092/05-10-SCHIP.pdf Retrieved September 25, 2007.

7 Kaiser Commission on Medicaid and the Uninsured, "The Uninsured: A Primer," Figure 7, p.8, October 2007 (www.kff.org/uninsured/upload/7451-03.pdf) and "No Shelter From the Storm: America's Uninsured Children," Families USA, Campaign for Children's Health Care, September 2006, pp. 7-8 (www.childrenshealthcampaign.org/tools/reports/Uninsured-Kids-report.PDF)

8 U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. "Table HI08. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics for Children Under 18: 2006." Available at: http://pubdb3.census.gov/macro/032007/health/h08_000.htm. Retrieved August 30, 2007.

9 Kaiser Family Foundation and Health Research and Education Trust (2007). "Employer Health Benefits: 2007 Annual Survey." Exhibit 2.2 Available at: http://www.kff.org/insurance/7672/upload/EHBS-2007-Full-Report-PDF.pdf. Retrieved September 13, 2007.

10 Paul Fronstin, "Employment-based Coverage: Is the Erosion in Coverage a Tipping Point?" Presentation at Alliance for Health Reform/Robert Wood Johnson Foundation Briefing (September 21, 2007). Available at: http://www.allhealth.org/briefing_detail.asp?bi=113. Retrieved September 27, 2007.

11 Kaiser Family Foundation and Health Research and Education Trust (2007). "Employer Health Benefits: 2007 Annual Survey." Exhibit 6.3 Available at: http://www.kff.org/insurance/7672/upload/EHBS-2007-Full-Report-PDF.pdf. Retrieved September 13, 2007.

12 Kaiser Family Foundation and Health Research and Education Trust (2007). "Employer Health Benefits: 2007 Annual Survey." Exhibit 2.2 Available at: http://www.kff.org/insurance/7672/upload/EHBS-2007-Full-Report-PDF.pdf. Retrieved September 13, 2007.

13 U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. "Table HI08. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics for Children Under 18: 2006." (http://pubdb3.census.gov/macro/032007/health/h08_000.htm). Retrieved August 30, 2007.

14 Paul Fronstin, "Employment-based Coverage: Is the Erosion in Coverage a Tipping Point?" Presentation at Alliance for Health Reform/Robert Wood Johnson Foundation Briefing (September 21, 2007). Available at: http://www.allhealth.org/briefing_detail.asp?bi=113. Retrieved September 27, 2007.

15 John Holahan and Allison Cook, "What Happened to the Insurance Coverage of Children and Adults in 2006?" Kaiser Commission on Medicaid and the Uninsured (September 2007). Available at: http://www.kff.org/uninsured/upload/7694.pdf. Retrieved September 25, 2007.

16 National Association of Children's Hospitals and Related Institutions, "Medicaid Matters to Children's Hospitals Fact Sheet," (September 2007) Available at: http://www.childrenshospitals.net/AM/Template.cfm?Section=Homepage&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=29394. Retrieved September 28, 2007.

17 Leighton Ku et al., "Improving Children's Health: A Chartbook about the Roles of Medicaid and SCHIP," Center on Budget and Policy Priorities (January 2007), p. 2. www.cbpp.org/schip-chartbook.pdf

18 Centers for Medicare and Medicaid Services, "Medicaid At-A-Glance 2005," (2005). Available at: http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/MedicaidAtAGlance2005.pdf. Retrieved September 25, 2007.

19 Dept. of Health and Human Services, "The 2007 HHS Poverty Guidelines," (2007). Available at: http://aspe.hhs.gov/poverty/07poverty.shtml. Retrieved September 25, 2007;

20 Robert Greenstein, "The Administration's Dubious Claims About the Emerging Children's Health Insurance Legislation: Myth and Reality," Center on Budget and Policy Priorities (July 2007). Available at: http://www.cbpp.org/7-17-07health.htm. Retrieved September 28, 2007.

21 Leighton Ku, Mark Lin, and Matthew Broaddus, "Improving Children's Health - A chartbook about the roles of Medicaid and SCHIP, 2007 Ed.," Center on Budget and Policy Priorities, January 2007. Available at: http://www.cbpp.org/schip-chartbook.htm. Retrieved September 25, 2007.

22 Congressional Budget Office, "State Children's Health Insurance Program," (May 2007), p. vii. Available at: http://www.cbo.gov/ftpdocs/80xx/doc8092/05-10-SCHIP.pdf. Retrieved September 25, 2007.

23 U.S. Census Bureau, Current Population Survey, 2007 Annual Social and Economic Supplement. "Table HI08. Health Insurance Coverage Status and Type of Coverage by Selected Characteristics for Children Under 18: 2006." Available at: http://pubdb3.census.gov/macro/032007/health/h08_000.htm). Retrieved August 30, 2007.

24 Peter Orszag, "Estimates of the Number of Uninsured Children who are Eligible for Medicaid or SCHIP" Letter to the Honorable Max Baucus, July 24, 2007. Available at: http://www.cbo.gov/ftpdocs/83xx/doc8357/07-24-Estimates_of_Uninsured_Children.pdf. Retrieved September 25, 2007.

25 Lisa Dubay, "Making Sense of Recent Estimates of Eligible but Uninsured Children," Kaiser Commission on Medicaid and the Uninsured (August 2007). Available at: http://www.kff.org/medicaid/upload/7685.pdf. Retrieved September 25, 2007.

26 U.S. Government Accountability Office, "Children's Health Insurance: States' SCHIP Enrollment and Spending Experiences and Considerations for Reauthorization." March 1, 2007, p. 31. http://www.gao.gov/new.items/d07558t.pdf